Posted!

Join the Conversation

Comments

Welcome to our new and improved comments, which are for subscribers only.
This is a test to see whether we can improve the experience for you.
You do not need a Facebook profile to participate.

You will need to register before adding a comment.
Typed comments will be lost if you are not logged in.

Please be polite.
It's OK to disagree with someone's ideas, but personal attacks, insults, threats, hate speech, advocating violence and other violations can result in a ban.
If you see comments in violation of our community guidelines, please report them.

Gil Smart: What's holding up medical marijuana? Everything

When Dr. Jessica Collins McCain returned to her hometown of Fort Pierce to practice medicine in 2015, one of her first patients was an older man with rectal cancer.

"His only question was, 'How can I control my pain when I can't even sit comfortably,'" said Collins McCain, a general practitioner at Whole Family Health Center, which also has an office in Vero Beach.

He also wanted to avoid opiates so he could stay lucid as family came from all over the country to bid him goodbye. McCain had no answer for him.

"He passed in agony," she said.

It didn't have to be that way.

In November, McCain became one of more than two dozen area physicians to complete state training that would permit her to help patients get medical marijuana. She stresses that her practice does not currently offer this service.

But more and more patients are asking about it, she said. And she would like to be able to connect patients with a substance that can ease their pain, quiet their seizures and comfort their demons.

"By no means will the availability of medical marijuana be a miracle for these patients," she said. But she'd love to have the "honor of seeing how a small change can make a great impact in individuals' lives."

Last fall, Florida voters took a similar tack. Overwhelmingly, they voted to approve Amendment 2, designed to make medical marijuana more accessible.

Here we are three months later, and it isn't.

There are a variety of reasons for this. The Florida Department of Health and the Legislature have yet to write the final rules, and early indications are that these rules will be pretty restrictive.

Many local governments are waiting to see what the state does before passing their own rules. Others have gone ahead and passed ordinances which might be described as punitive, restricting sales to gritty industrial locations that aren't particularly alluring to the average suburban cancer patients.

Then there are the doctors themselves, many of whom work for large medical groups that are averse to allowing physicians to recommend medical marijuana. Regardless of what voters here said, medical marijuana remains a federal Schedule I drug under the Controlled Substances Act, alongside heroin, LSD and other drugs "with no currently accepted medical use and a high potential for abuse," according to the US Drug Enforcement Administration's website.

All this means that, in the short term at least, medical marijuana will remain marginal and marginalized.

Which is pretty much the opposite of what voters said they wanted back in November.

Medical cannabis actually has been legal for limited therapeutic use in Florida since 2014. Some local physicians, like Stuart family physician Lisa Rankin, already have been helping patients obtain the substance.

"I have quite a few patients with cancer, traumatic brain injury, multiple sclerosis and PTSD," Rankin said. "Everyone has a legitimate medical problem and is either currently on narcotics, or the next step is narcotics."

Florida requires doctors to pass an 8-hour, $1,000 "compassionate medical cannabis" course before they can connect patients with the substance. More than 500 providers statewide have done so, including 10 in Martin County, six in St. Lucie County, five in Indian River County and seven in Brevard County.

Even then, they can't "prescribe" marijuana. Instead, they enter an order for the substance in the state's "Compassionate Use Registry" and the patient can fill the order via one of six approved dispensing organizations. Rankin said since there are no dispensaries nearby, her patients get theirs delivered.

Clunky? You bet. And it gets clunkier.

Under Amendment 2, doctors must treat patients for at least 90 days before they can enter them into the registry. But given that the state has until July to figure out what the final rules will be, and until September to implement them, Rankin wonders if her patients who are coming up on the 90-day mark will actually be able to get marijuana, or whether they will have to wait to see the new regulations.

"I've asked very pointed questions on this issue, and I haven't really gotten an answer," she said.

So far, it looks like the health department and state Senate want to keep control of the marijuana market in the hands of the companies already licensed by the state to grow, process and sell the substance. But Sen. Jeff Brandes, a St. Petersburg Republican, proposed legislation Wednesday that would completely rewrite the existing regulatory scheme.

So yeah, it's going to be a while before the state hashes everything out.

That means a waiting game for many local communities. St. Lucie County, for example, has imposed a six-month moratorium on hearing proposals for any dispensaries. Stuart City Commissioners soon could vote to extend a moratorium passed in November that's set to expire this month.

Others have gone forward with stringent regulations. Indian River County restricts sales to a few industrial areas near the railroad tracks. Vero Beach passed an ordinance requiring an armed guard on site.

And the Florida Association of Counties wants counties to be able to keep dispensaries out entirely, if that's what citizens want.

Patterson said all this sends a signal "that these are dirty, pseudo-legal operations."

"You want people in the community to realize a dispensary is on par with a pharmacy," he said. "But if you regulate them to the back alleys of industrial sectors, there will not be acceptance."

So medical marijuana might be legal in Florida. But whatever voters said last fall, we have a long way to go before Florida, on the whole, considers it normal.

Gil Smart is a columnist for Treasure Coast Newspapers and a member of the Editorial Board. His columns reflect his opinion. Readers may reach him at gil.smart@tcpalm.com, by phone at 772-223-4741 or via Twitter at @TCPalmGilSmart.

Docs trained in medical marijuana use

Treasure Coast and Brevard County doctors who have completed state training on medical marijuana: